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Provider Update: October 7, 2019

To:                  ADvantage Case Management, Home Care, Adult Day Health, and Assisted

Living Providers

Subject:4% Rate Increases Approval

Due to numerous questions related to authorizations not yet appearing in Authenticare and OHCA, we are resending this bulletin with updated information.

The Medicaid Services Unit (MSU) was informed today of the approval of the 4% rate increases by the Centers for Medicare and Medicaid Services (CMS).  The new rates will be effective on 10/1/2019.

The MSU worked with the Harmony vendor to perform a rate conversion to deploy the new rates, which will occur over this weekend.  This rate conversion has been thoughtfully planned so as to cause as little disruption to service providers as possible.

Data Conversion Process for ADvantage
  • By the end of the day on 9/28/2019:
    • Harmony will show all Planned Services and associated authorizations ending on 9/30/2019 at the old rate.
    • New lines will be added at the new rate with a begin date of 10/1/2019.
  • By 8:00 AM on Tuesday, 10/1/2019:
    • The Oklahoma Health Care Authority (OHCA) system will be showing all lines as ending on 9/30/2019.
  • By the end of the day on 10/1/2019:
    • All lines with a 10/1/2019 start date will begin transmitting to OHCA.
    • As OHCA can only consume 5000 new authorizations per day, it will likely take until the week ending 10/18/2019 for all lines to transmit to both OHCA and Authenticare.

NOTE:If you don't see a new line, please be patient; it should appear as the files are processed through all systems.

Data Conversion Process for State Plan Personal Care

  • By 8:00 AM on Monday, 9/30/2019:
    • Authenticare will show all ending 9/30/2019 lines and all beginning 10/1/2019 lines.

New Rates – ADvantage and State Plan Personal Care

State Plan Service Service Code Unit Type New Rate
Personal Care Assistant T1019 ¼ hour $4.21
State Plan Skilled Nursing Assessment T1001 Visit 62.40
ADvantage Waiver Services Service Code Unit Type New Rate
Personal Care Assistant T1019 ¼ hour 4.21
Advanced Supportive/Restorative T1019-TF ¼ hour 4.52
Respite - In Home  T1005 ¼ hour 4.21
Respite - In Home Extended S9125 Daily 175.55
CM Standard T1016 ¼ hour 15.29
Transitional CM Standard T1016-U3 ¼ hour 15.29
CM Very Rural T1016-TN ¼ hour 21.89
Transitional CM Very Rural T1016-TN-U3 ¼ hour 21.89
Adult Day Health  S5100-U1 ¼ hour 2.08
Adult Day Health - Therapies S5105-TG Episode 11.70
Adult Day Health - Personal Care S5105 Episode 8.27
Adult Day Health – Laundry S5105-U1 Episode 7.80
Assisted Living - Standard T2031 Daily 48.99
Assisted Living - Intermediate T2031-TF Daily 66.11
Assisted Living - High T2031-TG Daily 92.47
Self-Directed – Personal Services Assistant S5125 ¼ hour 3.56
Self-Directed – Advanced Personal Services Assistant S5125-TF ¼ hour 4.27
Physical Therapy G0151 ¼ hour 20.80
Occupational Therapy G0152 ¼ hour 20.80
Skilled Nursing Home Health Setting RN G0299 ¼ hour 15.60
Skilled Nursing Home Health Setting LPN G0300 ¼ hour 14.56
Extended State Plan Skilled Nursing RN G0299-TF ¼ hour 15.60
Extended State Plan Skilled Nursing RN G0300-TF ¼ hour 14.56
RN Assessment Evaluation T1002 ¼ hour 15.60
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